On most afternoons, you will find a quiet woman sitting in the back of the room at Hearth Inc.'s Ruggles Street Affordable Assisted Living facility with a smile on her face. If she knows you, she'll wave her hand, say "Hi" and ask you how you're doing.

For 25 years, she was a daily presence at the Women's Lunch Place. She is known well to the staff at the Pine Street Inn where she slept in a chair in the lobby for several years because of her fear of elevators. Her face is also familiar to those at the Boston Emergency Shelter Commission and to Mayor Thomas Menino, who met her during the annual homeless census. But until this past March, the 66-year-old African-American woman did not have a place she felt safe enough to call home and was one of many homeless elders living on the streets of Boston.

To the US Department of Housing and Urban Development, this woman is part of a recent success story. A few weeks ago, the department reported that national homelessness had dropped 30 percent between 2005 and 2007 based on statistics gathered each year from more than 3,800 cities and counties. The officials credit much of the decline to the "housing first" strategy, which aims to place the chronically homeless into permanent homes. That is exactly the Hearth Inc. philosophy that found this woman a comfortable place to live in Roxbury.

A stable home with supportive services made it possible for her to address her many medical problems (degenerative joint disease, diabetes, asthma, chronic pulmonary disease, and a recent leg fracture) as well as bouts with paranoia and delusion. Now, after five months, she is thriving.

Hearth, a small Boston agency dedicated to ending elder homelessness, provides her with the personal care, emotional support, medical care management, housekeeping, laundry, and meal preparation she needs help with. She has a level of comfort and happiness radically different from her life of so many years on the streets. She lives there with others with very different stories and backgrounds who have found, at last, a home of their own.
You don't become homeless for no reason.

The factors leading to elder homelessness are numerous and complex. Most homeless or at-risk elders live on very low, fixed incomes in Boston's high-cost housing market. They are often too frail to maintain employment. Many times, a senior's ill health results in the loss of a job and a bank account drained by medical expenses. They are left to subsist on Social Security payments, which at an average of $732 a month can't cover rent, heat, transportation, food, medicine, and other necessities. A lack of family support also can precipitate homelessness, and not just for geographic reasons either; many of our residents have family issues that result in long-term estrangements.

Another problem is that all too often elders with chronic conditions are placed in costly nursing homes, receiving far more care than they need while losing their independence. It doesn't have to be this way.

Homeless and at-risk seniors face unique challenges not fully addressed by solutions to family homelessness, which tend to focus on job skills and asset development. Since its 1991 inception, Hearth has found permanent homes for 1,300 homeless elders. Hearth now has seven residences in the South End, Roxbury, Dorchester, Brookline, and Jamaica Plain, and has become a model to like-minded organizations in Los Angeles and Minneapolis.

If we truly want to end homelessness, we need to address the reasons people become homeless and figure out a strategy that works for all those reasons.
Recent articles on homelessness have identified what we believe is the correct strategy: providing housing coupled with the services people need to remain housed. Moreover, both our experience in Boston and the recent HUD report documenting the success of the renewed national focus on ending homelessness suggest we know how to do it, if we can find the political will and financial resources to do so.